Home-based care providers are facing a significant surge in fraud enforcement, but the heightened scrutiny may also provide compliant operators an unexpected way to stand out. To differentiate themselves from fraudulent operators, home-based care providers are placing greater emphasis on documentation, audit readiness, accurate enrollment records and policy reviews to highlight their regulatory compliance, industry […]
CMS’ fraud crackdown was a recurring topic at the National Alliance for Care at Home’s Annual Meeting & Expo this week in Washington, from the main stage to breakout sessions to hallway conversations. I left the event thinking the home health enrollment moratorium’s next chapter might not be a simple choice between extending the nationwide […]
The Centers for Medicare & Medicaid Services (CMS) is moving to expand the Medicare home health Review Choice Demonstration (RCD) to California, citing fraud concerns. RCD is currently in place in Illinois, Ohio, Oklahoma, North Carolina, Florida and Texas. CMS filed a notice on Friday requesting expedited approval from the Office of Management and Budget […]
The moratorium on Medicare home health enrollment has blocked 250 agencies that applied from gaining approval, according to Kim Brandt, the deputy administrator and chief operating officer of the Centers for Medicare & Medicaid Services (CMS). The moratorium on hospice enrollment, meanwhile, has blocked 50 hospices from enrolling, she added, saying that she was surprised […]
A new federal pilot program will allow healthcare companies, including home-based care providers, to self-report and rectify conduct, such as compliance issues. The U.S. Department of Health and Human Services (HHS) and the Department of Justice (DOJ) Civil Division announced the six-month self-disclosure pilot program on Thursday. The pilot provides more clarity on resolving certain […]
On Tuesday, the Centers for Medicare & Medicaid Services (CMS) announced it deferred $1.2 billion in Medicaid payments to California directed toward personal home care services. The news follows CMS’ July deferral of over $1 billion in Medicaid payments for certain Medicaid claims, including personal care and home-based services, in Minnesota and California. “The devastating […]
States are going beyond federal requirements to detect fraud in Medicaid home care, cross-checking billed services against electronic visit verifications (EVVs) and analyzing claims for specific patterns, according to a new KFF report. Most states report that program integrity was one of their top three priorities, but the report’s authors cautioned that additional anti-fraud efforts […]
On Wednesday, a Brooklyn federal court sentenced the owner of adult day and home health companies to 76 months in prison for leading a multiyear Medicaid fraud and illegal kickback scheme that fraudulently billed the program about $64 million. The owner, Zakia Khan, pleaded guilty in 2025 to conspiring to defraud Medicaid and pay healthcare […]
As the Centers for Medicare & Medicaid Services (CMS) and Department of Justice (DOJ) intensify anti-fraud enforcement in the home health industry, established providers are focusing on reinforcing quality, documentation integrity, proactive oversight and other compliance models already in place, leaders told Home Health Care News. “Our strategy is really about making sure people understand […]
Last week, Sen. Susan Collins (R-Maine) introduced a bill that would reset the home health base payment rate and give the Centers for Medicare & Medicaid Services (CMS) new fraud-fighting tools. The bill serves as a microcosm of how lawmakers appear to view the home health industry: with equal parts support and suspicion. It’s a […]
